Bioresorbable Vascular Scaffold technology, the rise and fall in clinical practice

In 1977, interventional treatment of coronary artery disease was heralded by Andreas Gruntzig who started balloon angioplasty. Then in 1996 Schömig et al.3 introduced dual anti-platelet therapy instead of anticoagulant therapy. In 2001 Surrey et al.4 published first report on 45 patients who had negligible neo-intinal hyperplasia, one year after implanting Sirolimus eluting Bx VELOCITY stents. In 2006, Ormiston J et al. reported on the first in man implantation at mid LAD position.13 In 2008 the ABBSORB FIRST8 reported on 30 patients with single denovo coronary lesions with 94% device success. Then came the ABSORB II and currently patients in ABSORB III and IV are being followed. Initial results upto one year have shown encouraging results in terms of no inferiority to bench mark drug eluting stents. However results at 2–5 years have shown increased risk of target vessel revascularization and importantly a new risk of late scaffold thrombosis that emerged as a worry. The treatment of bioresorbable scaffold as a regular stent with similar sizing and implantation technique to other drug eluting stent has contributed to these results and better attention to proper sizing through more use of imaging, as well as more emphasis on post-dilatation has shown in subgroup analysis that it delivers better results. Furthermore avoiding use of BVS in small vessels and in complicated vessel lesions such as bifurcation or heavily calcified helps in ensuring a better long-term result. This remains to be seen in long-term results from ABSORB III and ABSORB IV studies as well as national registries. Currently use of BVS has been curtailed to within the scope of such big registries or in the theme of a study.